Children who receive a depression diagnosis in their primary school age have a substantially higher risk of a depression relapse during adolescence compared with children who did not receive a depression diagnosis during their primary school age, according to study results published in the Journal of Psychiatry Research. Boys demonstrated a higher relative risk of depression during early and late adolescence compared with girls.

Researchers in Munich, Germany obtained data for this study from Barmer Health Insurance, a major German health insurer, between the calendar years of 2005 and 2017. A total of 61,199 insured patients between the ages of 6 to 18 years of age, who were born in 1999, were included in the analysis. Depression incidence, defined by the International Statistical Classification of Diseases and Related Health Problems – 10th Revision (ICD-10) depressive episode diagnoses (F32), were evaluated.

In unstratified and stratified univariate analyses, researchers analyzed the absolute and relative risk of a depressive episode diagnosis (ICD-10 codes F32.x or F33.x) based on a depression diagnosis in primary school age (ie, 6-10 years).

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Girls had a higher incidence of depressive disorders than boys from 13 years of age, with a peak observed at 15 years of age. Girls exhibited an approximately 3-fold higher incidence of depressive disorders at 15 years. The rise in rate of depressive disorders reached a maximum at age 17 years in girls (3.0%; 95% CI, 2.9-3.2), whereas the maximum was reached in boys at age 18 years (1.4%; 95% CI, 1.4-1.5).

Among 525 children who had an incident diagnosis of ICD-10 F32.x in primary school age, additional physician contact was associated with a diagnosis of ICD F32.x or F33.x for 23.2% (95% CI, 19.6-26.9) of children during adolescence and 22.9% (95% CI, 19.3-26.5) of children during late adolescence (ie, 15-18 years).

Additionally, children who received a diagnosis of depression during primary school age had a 11.5 (95% CI, 9.7-13.5) times higher depression risk during early adolescence (ie, 11-14 years) vs children who did not receive a diagnosis of depression during primary school age. A diagnosis of depression in boys during primary school age was associated with a higher relative risk of boys receiving a depressive disorder diagnosis during early (14.2; 95% CI, 11.4–17.8) and late adolescence (4.2; 95% CI, 3.3–5.2) compared with girls (early: 9.5; 95% CI, 7.4–12.1 vs late: 2.1; 95% CI, 1.7–2.7).

A limitation of the study was the exclusion of children less than 6 years of age, which the researchers said reduced their ability to determine whether the incidence of depressive symptoms in primary school age was the first episode.

The researchers suggested “that the diagnosis of depression in primary school-age for boys has a greater predictive value for another medical consultation due to a depressive episode in early or late adolescence compared” with girls, but the predictive power of a depression diagnosis in primary school age in both sexes “is especially important for early adolescence, where the overall incidence of depressive disorders is still low.”


Frey M, Obermeier V, von Kries R, Schulte-Körne G. Age and sex specific incidence for depression from early childhood to adolescence: A 13-year longitudinal analysis of German health insurance data [published online June 2, 2020]. J Psychiatr Res. doi:10.1016/j.jpsychires.2020.06.001.